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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. <br /> scale or dimensions, north arrow,and location and distance to nearest road. _ - - . 3-s 1S- <br /> Please print all information. Reviewed by Dat <br /> Personal information you provide may be used for secondary purposes Priva Law,s.15.04 1 m . 7i <br /> Prop y Owner Property Location ❑ <br /> U Govt. Lot Y. S 13 T4 N R E (or) W <br /> Propert w er's Mailing A00ress Lot# Block# Subd.Name or CSM# <br /> City tate Zip Code Phone Number ❑City ❑Village EJTo N rest o 2 p`Q <br /> (]New Construction Use: Residential/Number of bedrooms_ Code derived design flow rate GPD <br /> ❑ Replacement Publicor commercial-Describe: <br /> Parent materialn Flood Plan elevation if applicable ft. <br /> General comments and recommendations: <br /> -1-ax138 <br /> c/ Boring# EMoring 4 ,, <br /> r ❑Pit Ground surface elev�t?�J-74ty. r�/ Depth to limiting factor // in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> 04 L-) <br /> vv� - <br /> ❑ Boring# ❑Boring <br /> ❑Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> Effluent#1 =BOD,>30 5 220 m /L and TSS>30:5 150 MIV Effluent#2=BOD,>30<_220 m /L and TSS>30 s 150 m /L <br /> CST Name(Please Print) Signat XCST Number <br /> Cory Jackson Oilk824339 <br /> Address Date Eva uatio 'on cted Telephone Number <br /> 24884 State Rd 35 Siren WI 54872 (p-)"3- Z 715 791 4768 <br /> SBD-8330(R04/15) <br />